Discussing the Controversy of Substance Use: Disease or Choice?

First, let’s clarify our terminology to educate and inspire others to use appropriate language when discussing this topic. Stay tuned for a future blog where we delve deeper into the terminology surrounding addiction and recovery. While addiction describes the development of problematic substance use patterns, it's crucial not to label individuals as "addicts," as people are more than their challenges. Substance use can escalate into a substance use disorder, commonly known as addiction. In my discussions, I prefer terms like "person with a substance use disorder" or "person who uses substances." It’s essential to focus on the broader context rather than perpetuate societal stigma around substance use. Substance use disorders involve continued substance use despite negative consequences that may arise. This can include various behaviors such as drug use, alcohol consumption, gambling, and more, all of which can lead to significant personal problems. Stay connected with Howtolivewhiledying for an upcoming discussion on the specific impacts of substance use disorders on areas like employment, relationships, education, and home life.

Relationships with the Brain and Genetics

Within our brains, dopamine plays a critical role, being released during activities that fulfill desires such as eating when hungry or achieving goals. This neurotransmitter creates a sense of reward and satisfaction in our brain’s reward system. For instance, when we smoke a cigarette and experience stress relief, dopamine signals to our brain that this action is beneficial for reducing stress. Consequently, our brain may crave this relief during stressful times, creating a strong reward association with smoking.

Consider adolescents, whose still-developing brains, particularly the underdeveloped frontal lobe and amygdala, may struggle with impulse control. When faced with peer pressure, an adolescent might experiment with substances like marijuana. This initial use doesn’t necessarily indicate a substance use disorder, but it can train the brain to seek similar coping mechanisms under pressure, eventually leading to a substance use disorder.

Imagine two individuals turning 21 and going to a bar for the first time. Despite drinking the same amount over the same period, one may develop a substance use disorder while the other does not. They both made the same risky choice, so why is it different? Genetic predisposition, such as a family history of alcohol use disorders, can influence susceptibility. For instance, one person may responsibly enjoy 1-2 drinks, while another might find it difficult to stop, leading to excessive drinking and even blackout episodes. These variations illustrate how external factors beyond personal control can impact the effects of alcohol, or other substances, and even activities.

Choice or Disorder?

Years ago, debates raged over whether addiction constitutes a choice or a disease/disorder. In this emerging blog, I find it crucial to address this issue to combat lingering societal stigmas. Misinformation or lack of education often contributes to these stigmas. Talking about these topics can increase understanding and decrease stigma.

The American Medical Association (AMA) first defined alcoholism as a disease in 1956 and expanded this definition to include other substances in 1987. In 2011, the American Society of Addiction Medicine (ASAM) characterized addiction as a chronic brain disorder. Over time, these shifts in perspective have helped challenge the notion that individuals simply choose to develop substance use disorders.

Consider Type 2 Diabetes, which can result from poor diet and lifestyle choices. Yet, when someone develops diabetes, we recognize it as a serious medical condition despite its origins in lifestyle. Similarly, engaging in substance use or other potentially addictive behaviors carries risks. While individuals may choose to experiment with substances, they cannot control pre-existing genetic factors influencing their brain's response to these activities.

Conclusion

Disorders do not discriminate; anyone can be at risk of developing a substance use disorder or engaging compulsively in behaviors like sex, gaming, or gambling that affect the brain’s natural reward system. Genetic predisposition, social pressures, family dynamics, and other factors can all contribute to individual reactions to substances or behaviors. While some risks can be mitigated, substance use disorders often manifest before individuals recognize the problems they cause in their lives. Increasing evidence supports the view that addiction is a disease rather than a choice, offering hope that the debate surrounding substance use disorders can be dismantled.